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Objective: The aim of the present study was to evaluate complaints in people with Ménière's disease (MD) with and without migraine and headache to study the association between MD and Vestibular Migraine (VM). We believe this will help us understand if these two disorders represent a disease continuum in that they may share a common aetiology., Methods: The study used a retrospective design and included data of 911 patients with MD from the Finnish Ménière Federation database. The study participants had a mean age of 60.2 years, mean duration of disease of 12.6 years, and 78.7% of the participants were females. The questionnaire data comprised of both disease specific and impact related questions. The data were analyzed using the Mann-Whitney U test, the Kruskal Wallis H test, logistic regression analyses, and decision tree analysis., Results: Migraine and headache was reported by 190 subjects (20.9%) and 391 subjects (42.9%) respectively. We found that patients that could be classified as VM in the study (i.e., those with frequent vertigo spells associated with migraine) more often reported complaints of severe MD symptoms, had reduced health-related quality of life, suffered more from anxiety, had more neurological complaints, and experienced a reduced sense of coherence than the non-migraneous patients with MD. However, neither the decision tree analysis nor the logistic regression analysis could reliably discriminate VM from MD patients., Conclusion: Our study results confirm that MD is frequently associated with headache and migraine. In addition, results also indicate that migraine provokes the severity of MD. We suggest that MD and VM may share similar pathophysiological mechanisms. Hence, the future MD classification systems should include a category referred to as 'MD with migraine' that will include patients with VM., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: The study evaluated the driving habits and risk of traffic accidents among people with Ménière's disease (MD) in Finland., Materials and Methods: The study used a cross-sectional survey design. Members of the Finnish Ménière Federation (FMF) were contacted and requested to participate in an online survey. In total, 558 FMF members (58.7% response rate) responded to the survey., Results: People with MD were responsible for significantly fewer traffic accidents (0.8%) annually than individuals in the general population (1.7%). In addition, the lifetime risk of car accidents was lower among subjects with MD (8.3%) than that among individuals in the general population (24 to 28%). Nearly half of the total participants had either reduced the frequency of driving or had given up driving because of their condition. Factors such as gender, balance problems, visual problems with visual aura, and syncope during vestibular drop attacks can help explain the reasons for giving up car driving. One third (35.9%) of the participants were able to anticipate the MD attack before they decided to drive a car. Participants with falls during a vestibular drop attack, attacks of rotary vertigo, syncope during vestibular drop attacks, and those who were of a younger age were at a higher risk of experiencing a vertigo attack while driving a car. The most common strategies to avoid car accidents were selective driving and not driving when symptoms appeared., Conclusion: The results show that people with MD are at a lower risk of traffic accidents than individuals in the general population, which can be explained by selective driving.

Objectives: The aim of the current study was to further collect evidence that would confirm the hypothesis that vestibular drop attacks (VDAs) could cause syncope in patients with Ménière's disease (MD)., Materials and Methods: A cross-sectional survey design was employed in the present study. An Internet-based survey was administered on 602 individuals with MD. The mean age of the participants was 56.7 (25-75) years, and the mean duration of the disease was 12.4 (0.5-35) years., Results: VDAs with varying severity were present among 307 (50.7%) patients and led to fall in 92 patients, and syncope occurred in 45 patients with VDA. The overall percentage of syncope due to MD was 4.7%. Factors, such as duration of disease, age, and gender of the patient, did not explain attacks of syncope. Migraine and headache were not associated with syncope. Syncope was witnessed in 23 and self-reported by 22 patients. Syncope was associated with frequent VDA, duration of VDA, and falls that occurred during VDA. Patients with syncope reported the experience as frightening, had reduced general health-related quality of life, had higher anxiousness scores, and suffered more from fatigue. They also experienced problems with work, employment, and social restrictions., Conclusion: Approximately 5% of patients with MD suffer from syncope, and syncope occurs among patients with VDA. In vestibular syncope, the sympathetic tone is lost, and baroreflex feedback is inhibited leading to fall and syncope. The consequences of vestibular syncope are severe, and patients face injuries and a significantly reduced quality of life.

Objective: Experiments in humans and animals indicate that vestibular influx through vestibular sympathetic reflex is an important and vital part of the regulatory system of circulation. The otolith organ adjusts the circulatory responses through the vestibular sympathetic reflex during an upright stance and may trigger a vasovagal attack of syncope. The aim of the present study was to evaluate the prevalence and association of syncope attacks among patients with Ménière's disease (MD). Vestibular syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously in people with vestibular disorders and without localizing neurological deficit., Methods: During clinical interactions, we encountered 5 patients with syncope during a Tumarkin attack of MD. Thereafter we evaluated data from 952 patients collected with a questionnaire from the Finnish Ménière Association (FMA). The data contained case histories with special attention to Tumarkin attacks, participation restriction, migraines, and syncope attacks. The mean age of the subjects participating in the study was 60.6 years (range 25-75 years). The duration of the disease was on average 9.8 years (range 0.5-35 years)., Results: In the current study sample, attacks of syncope were reported by 38 patients (4%) in association with the vertigo attack. Syncope was associated with Tumarkin attacks (X 2 =16.7, p<0.001), migraine (X 2 =7.4, p<0.011), history of ischemic heart disease (X 2 =6.0, p<0.025), and history of cerebrovascular disease (X 2 =11.7, p<0.004). Duration of MD was correlated with syncope. Syncope was provoked by physical strain and environmental pressure, and was associated with impairment of the visual field (i.e., visual blurring). In logistic regression analysis, syncope was significantly associated with Tumarkin attacks (odds ratio 3.2), migraines (odds ratio 2.3) and nausea (odds ratio 1.3). The attack of syncope was experienced as frightening, and general health related quality of life (HRQoL) was significantly worsened. Also, the patients suffered more from fatigue., Conclusion: The current study indicates that patients with MD who suffer from Tumarkin attacks can suffer from syncope. It confirms the role of the otolith organ in controlling the circulatory homeostasis of the body. The actions are mediated through the vestibular sympathetic reflex., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: The current study aimed to better understand how patients and their significant others (SOs) cope with Menière's disease (MD)., Design: The study used a cross-sectional design and the data were collected using questionnaires., Study Sample: Seventy-five dyads in which one person had MD., Results: SOs of patients with MD not only experienced activity and participation restrictions but also had positive experiences. In relational quality, the SOs reported uncertainty of their future, limited visits in noisy places, limited activities as walking, watching TV, and participating in social life. The illness interference correlated with the patients' complaints, and most significant was the problem of imbalance. The quality of life was significantly reduced in patients with MD, and the illness interference in terms of quality of life was correlated with the SOs in items related to mood and anxiety. The stress related conditions of the SOs were correlated with two positive items (e.g. alleviating the stress factor). The SOs could also identify one positive item (i.e., improved relationship)., Conclusions: Perceptions of MD as interfering in couples' lives influence dyadic coping in unique ways. The current study identified that dyadic coping has both positive aspects and limitations as a consequence of their partner's MD.

Background: Ménière's disease (MD) is a chronic and, in part, intermittent illness that poses multiple challenges for both the physical and psychological well-being of patients, as well as on those around them. The patients face psychosocial consequences, which include disruptions to life goals, employment, income, relationships, leisure activities, and daily living activities that also influence their family members and friends. However, there is a limited understanding of the impact of MD on significant others (SOs)., Purpose: The current study was aimed at identifying how the SOs of patients with MD respond to different aspects of the impact of the disorder on health and life (i.e., psychological aspects, activities, participation, and positive aspects)., Research Design: The study employed a cross-sectional survey design., Study Sample: The study sample was 186 SOs of patients with MD who were recruited through Finnish Ménière's Federation., Data Collection and Analysis: Participants completed a 25-item structured questionnaire focusing on different aspects of the impact of the disorder on health and life, and also provided some demographic information. Data were analyzed using Kruskal-Wallis test, Pearson's correlation, and K-means cluster analysis techniques., Results: Examination of response patterns suggests that the disorder had, on average, a marginal effect on SOs' psychological aspects, activities, and participation as the SOs generally focused on complaints. Interestingly, SOs reported some positive consequences as a result of their partners' condition. The results show a limited association between SOs' demographic variables and response patterns. The Pearson's correlation suggested a strong association between the subscales psychological aspects, activity limitations, and participation restrictions. Also, a weak negative correlation was observed among positive aspects and participation restrictions. The cluster analysis resulted in three clusters, namely, (1) "nonengaged," (2) "supportive," and (3) "concerned.", Conclusions: The current study results identify that the SOs' reaction to patients' condition varies and this may be from coping with victimization. Although the impact of MD on SOs is limited, some of the SOs may have more severe consequences and may require rehabilitation. The information gathered about SOs' coping and adjustment in this study can also help while developing management and/or rehabilitation plan for people with MD., (American Academy of Audiology)

The purpose of the present study was to characterize the occurrence of Tumarkin attacks in patients with Ménière'sdisease (MD), and to study its association with reported complaints, severity of consequences, and also self-reported work ability. The study used a cross-sectional design. Data obtained from the Finnish Ménière Federation using an electronic survey was analyzed. 602 people with MD responded to the survey (62% response rate) with a mean age of 56.7 years and a mean duration of the disease 12.4 years. 49% of the respondents experienced Tumarkin attacks, which lasted for a few seconds to a few minutes. There were significant differences in complaints reported by MD patients with and without Tumarkin attacks. Respondents with Tumarkin attacks experienced various consequences, including tripping, falls, fear, anxiety, problems in dyadic life, and even transient loss of consciousness. Respondents with Tumarkin attacks had more frequently applied for pension than those not having Tumarkin attacks. On an average, respondents with Tumarkin attacks had less self-reported working ability when compared to those without Tumarkin attacks. The current study results suggest various differences in terms of complaints reported, severity of consequences, and the self-reported working ability in MD patients with and without Tumarkin attacks. Hearing healthcare professionals must examine Tumarkin attacks and their consequences in patients with MD during clinical examinations. In addition, the therapy should focus on alleviating the consequences and improving work ability.

Purpose: In this article, we present the details and the pilot outcome of an Internet-based self-help program for Ménière's disease (MD)., Method: The Norton-Kaplan model is applied to construct a strategic, person-focused approach in the enablement process. The program assesses the disorder profile and diagnosis. In the therapeutic component of the program, the participant defines vision and time frame, inspects confounding factors, determines goals, establishes a strategy, and starts to work on the important problems caused by the disorder. The program works interactively, utilizes collaboration with significant others, and enhances positive thinking. Participants took part in an Internet-based self-help program. Data were collected interactively using open-ended and structured questionnaires on various disease-specific and general health aspects. The pilot outcome of 41 patients with MD was evaluated., Results: The analysis of the pilot data showed statistically significant improvement in their general health-related quality of life (p < .001). Also, the outcome of the Posttraumatic Growth Inventory (Cann et al., 2010) showed small to moderate change as a result of the intervention., Conclusions: The Internet-based self-help program can be helpful in the rehabilitation of patients with MD to supplement medical therapy.

The aim of the present study was to evaluate the prevalence and associated factors for syncope among patients with Ménière's disease (MD). An attack of syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously and without a localizing neurological deficit. The study used an across-sectional survey design. Information from a database consisting of 961 individuals was collected from the Finnish Ménière Association. The data contained case histories, general health-related quality of life (HRQoL), and impact measurements of the complaints. In the current study sample, syncope occurred in 12.3% of the patients with MD. It was more prevalent among elderly persons and among those with a longer duration of MD. Syncope was significantly associated with disturbances of otolith function reflected as Tumarkin attacks, gait and balance problems, environmental change of pressure, and physical strain. It was also associated with visual blurring; in fact, patients with otolith dysfunction in MD often experience visual field changes. It was also associated with headache, but not with migraine. Syncope was experienced as frightening and HRQoL was significantly worsened. The patient had higher anxiety scores, and suffered more from fatigue. The results demonstrate that neurally mediated syncope occurs in patients with an advanced form of MD who suffer from Tumarkin attacks due to failure in otolith function. The mechanism seems to be triggered through the vestibular sympathetic reflex when the otolith system fails due to disrupted utricular otolithic membrane mediate erroneous positional information from the otolith organ to the vasomotor centres in the brain stem and medulla.

Objective: This paper presents a summary of web-based data collection, impact evaluation, and user evaluations of an Internet-based peer support program for Ménière's disease (MD)., Design: The program is written in html-form. The data are stored in a MySQL database and uses machine learning in the diagnosis of MD. The program works interactively with the user and assesses the participant's disorder profile in various dimensions (i.e., symptoms, impact, personal traits, and positive attitude). The inference engine uses a database to compare the impact with 50 referents, and provides regular feedback to the user. Data were analysed using descriptive statistics and regression analysis., Study Sample: The impact evaluation was based on 740 cases and the user evaluation on a sample of 75 cases of MD respectively., Results: The web-based system was useful in data collection and impact evaluation of people with MD. Among those with a recent onset of MD, 78% rated the program as useful or very useful, whereas those with chronic MD rated the program 55%., Conclusions: We suggest that a web-based data collection and impact evaluation for peer support can be helpful while formulating the rehabilitation goals of building the self-confidence needed for coping and increasing social participation.

Menière's disease is a chronic condition with a prevalence of 200-500 per 100,000 and characterized by episodic attacks of vertigo, fluctuating hearing loss, tinnitus, aural pressure and a progressive loss of audiovestibular functions. Over 150 years ago, Prosper Menière was the first to recognize the inner ear as the site of lesion for this clinical syndrome. Over 75 years ago, endolymphatic hydrops was discovered as the pathologic correlate of Menière's disease. However, this pathologic finding could be ascertained only in post-mortem histologic studies. Due to this diagnostic dilemma and the variable manifestation of the various audiovestibular symptoms, diagnostic classification systems based on clinical findings have been repeatedly modified and have not been uniformly used in scientific publications on Menière's disease. Furthermore, the higher level measures of impact on quality of life such as vitality and social participation have been neglected hitherto. Recent developments of high-resolution MR imaging of the inner ear have now enabled us to visualize in vivo endolymphatic hydrops in patients with suspected Menière's disease. In this review, we summarize the existing knowledge from temporal bone histologic studies and from the emerging evidence on imaging-based evaluation of patients with suspected Menière's disease. These indicate that endolymphatic hydrops is responsible not only for the full-blown clinical triad of simultaneous attacks of auditory and vestibular dysfunction, but also for other clinical presentations such as "vestibular" and "cochlear Menière's disease". As a consequence, we propose a new terminology which is based on symptomatic and imaging characteristics of these clinical entities to clarify and simplify their diagnostic classification.

Objective: To explore the impact, reactions and coping methods of the significant others (SOs) of people with Ménière's disease (MD)., Design: SOs of people with MD were asked to answer open-ended questions reporting the 'life effects' and 'positive experiences' they have had as a result of the partner's condition. The replies to the 'life effects' question was categorized using the WHO-ICF framework. The responses of 'life effects' from this study and the 'positive experiences' reported in a recent study ( Manchaiah et al, 2013 ) were evaluated with K-means clustering analysis., Study Sample: Eighty-eight SOs (42 male, 42 female, and four did not state gender)., Results: While the SOs mainly listed their own problems, a significant number of responses related to the problems of their partner. Personal perspectives tended to focus on the consequences of their partner's condition, whereas in perspectives of their partner they focussed on his/her symptoms. Further, replies from 81 SOs were used in evaluation of responses and were classified into four categories: constrained life attitude; disease burden attitude; care and support attitude; and social isolation attitude., Conclusions: The results of this study support the importance of including the SO of people with MD in the rehabilitation process.

Objective: It is common to study and understand how various illness and disorders result in negative consequences. However, positive experiences have been reported in a range of disabling conditions including multiple sclerosis, heart disease, physical and sensory disabilities. This paper presents a literature review of studies that have explored positive experiences associated with acquired hearing loss, Ménière's disease, and tinnitus., Design: A review of the peer reviewed scientific literature., Study Sample: A comprehensive search strategy identified 15 articles after applying inclusion criteria., Results: A range of positive experiences have been reported by patients with hearing and balance disorders and by their significant others. Associations between demographic variables (e.g. age, gender), audiological variables (e.g. severity of the condition, duration) and the reported positive experiences are low. In Ménière's disease, self-reported positive experiences can predict the impact of the condition. However, this phenomenon has not yet been demonstrated in relation to hearing loss and tinnitus., Conclusions: Positive experiences associated with audio-vestibular disorders have been demonstrated. Further research is needed on the long-term benefits of the encouragement of such experiences and positive attitudes in persons with hearing loss, tinnitus, and imbalance.

Objective: To investigate how the ability to adapt, measured by the sense of coherence (SOC), is related to specific complaints of Menière's disease (MD) and the disease specific and general health related quality of life (EQ-5D) and on disease specific impact of the disease (MD-impact)., Methods: Postal survey, including a structured questionnaire on EQ-5D, SOC, symptoms, positive experiences, and the impact of MD, was sent to the members of the Finnish Menière Federation, reporting a diagnosis compatible with the condition. A sample of 547 members replied and were analyzed., Results: The SOC reflected the disabilities caused by symptoms of MD and psychosocial factors including verbal score scale (VSS) anxiety (p<0.01) and loss of vitality (p<0.001). Higher SOC scores were related to better scores in EQ-5D and lower scores in MD-impact. Positive attitudes consequential to MD were associated with higher SOC scores reflecting better control over the consequences of disease., Conclusion: SOC is an element of patient's attitude toward illness and correlates with perceived good health. Patients with higher SOC scores are more content with their quality of life. Future research should focus on whether influencing modifiable psychological factors, such as positive attitudes, could improve adaptive ability in MD., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: Aural fullness in Ménière's disease and the predisposing and consequential factors were investigated and possible consequences of aural fullness on participation activity were explored., Methods: 726 subjects of the Finnish Ménière Association replied to a questionnaire focusing on symptoms of Ménière's disease, sense of coherence, attitude, participation restriction, and general health-related quality of life (EQ-5D). In the analysis, the severity of the disease was controlled., Results: 68% of the subjects had aural fullness and in 37% it was moderate or strong. Aural fullness was rated as the worst problem by 4.4% of the subjects. Females reported more aural fullness than males. Tinnitus, hyperacusis and balance problems were significant predictors of aural fullness. Aural fullness was associated with reduced quality of life and complaints such as vertigo attacks, balance problems and hearing loss. Analysis based on participation restriction indicated that severe aural fullness leads to social isolation., Conclusions: Largely, psychological factors and personal traits modify problems experienced by aural fullness. Relaxation was the only statistically significant method that alleviated aural fullness., (© 2014 S. Karger AG, Basel.)

Objective: To determine the effects of their partners' MD on the significant others of the patients., Design: Open-ended questionnaire., Study Sample: Significant others of members of the Finnish Ménière's Federation., Results: The predominant responses concerned effects on their lives and lifestyle--participation restrictions (effects on personal and community life)--and on personal contextual factors (uncertainty of life). In contrast they fail to list such effects of the patients, focussing rather on the patients' symptoms. Five percent of the responses given entailed positive experiences., Conclusions: Significant others of patients with MD listed a wide range of effects of their partner's condition on them. We encourage doctors and therapists to include the significant others in the rehabilitation process to enable them to understand the patient's condition, to help the significant other, and so better support the patients concerned.

Objective: To explore the perceived consequences of tinnitus in patients with long-standing Ménière's disease (MD)., Method: A questionnaire-based cross-sectional investigation of 183 randomly selected members of the Finnish Ménière's Federation. It assessed general health related quality of life (EQ-5D), a participation restriction scale, self-listed consequences and a rating of effects of MD on life., Results: When the effects of the other cardinal symptoms of Ménière's disease were partialled out, the main reported impacts of tinnitus related to anxiety, sleep and depression. It also contributed to some difficult listening situations and to interactions with significant others. Tinnitus explained a significant component of disease-specific quality of life (QoL), but did not relate significantly to the generic measures used. However, the measure 'mood' in the QoL scale was significantly associated with severe tinnitus., Conclusion: The most important specific impacts of tinnitus in chronic Ménière's disease relate to broadly psychological factors and mood., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

The purpose of this study was to determine the factors explaining changes in the generic quality of life among patients with Menière's disorder (MD) and to evaluate the EuroQol 5D (EQ-5D) quality-of-life measures. A questionnaire focusing on symptoms and disabilities caused by MD was collected from 726 individuals. General health-related quality of life (EQ-5D) was evaluated using the time trade-off (TTO) and visual-analogue scale (VAS). Personal traits were measured with the sense of coherence. The TTO-VAS score difference was modeled with activity limitations, participation restrictions, attitudes, and symptoms. For TTO as the outcome measure, one symptom-based, three attitude-based, one activity limitation, and one participation restriction item explained 43% of the variability. For VAS, six attitude-based, one symptom-based, three activity limitations, and one participation restriction item explained 43% of the variability of the data. The correlation between TTO and VAS (r=0.515, P<0.001) explained only 27% of the variance. The difference between TTO and VAS was reflected in attitudes towards the illness. The model explained 10% of the variability in the VAS and TTO difference. There was a disease duration effect in the TTO-VAS difference. In conclusion, a symptom-based model combined with disabilities provided a good description of general quality of life in MD. The TTO-based and VAS-based evaluation explained somewhat different aspects of MD. The difference between TTO and VAS could be described as an attitude toward the ailment. Evaluation of disabilities and the difference in TTO and VAS can be used to guide the rehabilitation to promote attitude change.

Objective: To explore factors that determines tinnitus complaint behaviour in patients with chronic long-standing Menière's disorder., Design and Setting: A questionnaire-based cross-sectional investigation. This included the Oto-neurological questionnaire, the Hearing Disability and Handicap Scale (HDHS), Hearing Measurement Scale (HMS) on sound localisation and the Dizziness Handicap Questionnaire (DHQ)., Participants: Randomly selected 183 members of the Finnish Menière's Federation., Intervention: Postal questionnaire., Main Outcome Measure: International Tinnitus Inventory and impact of tinnitus., Results: The 183 patients,[36 men and 147 women; mean age, 63 years] had their Meniere's disorder-like symptoms, with a mean of 18 years [range, 1-43], 19% of patients ranked tinnitus as their most severe symptom, and 10% experienced tinnitus as causing a severe or very severe impact. Regression analysis indicated that 41% of International Tinnitus Inventory variance and 28% of tinnitus impact variance were explained by the cardinal symptoms of Menière's disorder. Furthermore, 40% of International Tinnitus Inventory and 25% of tinnitus impact variance were explained by symptom-related disabilities (HDHS, HMS and DHQ). Aural pressure, hearing loss and gait problems were the most important predictors of tinnitus complaint. Understanding what people say and limitation of activities because of vertigo were the most important related disabilities., Conclusion: Tinnitus shares a significant variance with the other cardinal symptoms in patients with long-standing Menière's disorder. As the impact is significantly related to activity limitations based on hearing disability and vertigo, the results suggest that therapeutic efforts to reduce tinnitus in Menière's disorder should include the alleviation of balance and hearing problems., (© 2011 Blackwell Publishing Ltd.)

Purpose: To study the inheritance and characteristics of familial Meniere disease in Finland and genetic linkage to the previously proposed locus on chromosome 12p12.3., Methods: Sixteen Meniere families recruited from Kainuu Central Hospital and Helsinki and Oulu University Hospitals in the period 2001-2004 were reevaluated in 2009 using hospital records and mailed questionnaire forms. Ten highly polymorphic microsatellite markers were selected from the area of chromosome 12p12.3 and studied for linkage using the GENEHUNTER protocol., Results: The families showed autosomal dominant inheritance without cosegregation with migraine. Anticipation was seen only in one family, and in the rest of the families, the age of onset varied randomly among generations and individuals. The severity of the disease was not related to descending generations. None of the maximum logarithm of odds (LOD)/heterogeneity LOD scores in the analysis of chromosome 12p12.3 in Finnish Meniere families reached a significant value of 3.0 (maximum cumulative LOD score: -7.29, heterogeneity LOD: -0.95, α = 0.4)., Conclusions: Families affected by Meniere disease are highly heterogeneous. Migraine, age at onset, anticipation, or penetrance was not a shared feature. The findings support the multifactorial nature of the disease and indicate that genetic heterogeneity exists within familial Meniere disease.

The objective of this study was to determine the influence of positive experiences on the quality of life of patients with Ménière's disorder. Its deign comprised a cross-sectional investigation of members of a self-help group, using a questionnaire of positive experiences, an oto-neurological questionnaire, EuroQol, and Ménière's impact rating. The study sample was 542 members of the Finnish Ménière Federation. Results showed that the positive questions explained 21% of the variance of the EuroQol TTO, 31% of the EuroQol VAS measure, and 35% of the Ménière's impact. This compared with 40% of the variance explained by symptomatic complaints. When both the symptoms and positive measures were taken together, there was an increase in the proportion of the variance explained for the VAS (42%) and Ménière's rating (50%), but not for the TTO (42%). A perspective on the disorder was the main positive experience associated with the increased variance explained. Positive experiences have a significant impact on self-rated quality of life. The results suggest that encouraging a positive perspective on the condition, in addition to treating the underlying symptoms, could be useful in rehabilitative management.

Conclusions: Eight aspects of self-reported positive experience in Ménière's disorder were identified, of which 'Perspectives on one's disease' can predict the impact of the condition., Objectives: To determine the types of positive experiences related to attitudes and expectations and their relationship to the impact of Ménière's disorder on the individuals' lives., Methods: A postal survey of the members of the Finnish Ménière's Association including a structured questionnaire on positive experiences that have been reported by people with Ménière's disorder., Results: Eight positive factors were derived, explaining 59% of the total variance. The main factors were 'Personal development', 'Patient Association', 'Perspective on one's disease', Acceptance of limitations', 'Beneficial life-effects' and 'Use condition to self-advantage'. Of these only 'Perspective on one's disease' related significantly to measures of the impact of the condition.

Objectives: We sought to determine the value of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) in subjects with Meniere's disorder in relation to their quality of life., Methods: We asked 228 members of the Finnish Meniere Federation to report the effects that Meniere's disorder had on their lives. The replies were classified on the basis of the ICF classification and related to the EuroQol 5D score and disease-specific impact. Logistic regression and decision tree analyses were used to determine the relationships., Results: Seventy percent of the patients listed impairments, 39% activity limitations, 47% participation restrictions, 16% effects on environmental contextual factors, and 28% effects on personal contextual factors. The EuroQol 5D score was explained by reported vertigo, anxiety, fatigue, restriction of life, and communication problems. The disease-specific impact was explained by episodes of vertigo, fatigue, communication problems, inability to work, restriction of life, and uncertainty of life. Both analysis models provided the same outcome variables, although the decision tree separated the results better (80%) into correct classes than did logistic regression analysis (60%)., Conclusions: Self-reported participation restriction, activity limitation, and personal contextual factors describe the limitations of general life in subjects with Meniere's disorder. The use of the ICF classification provides an instrument that can be used in enablement of subjects with Meniere's disorder.

Objective: To define the main consequences of Ménière's disease as perceived by individuals with the condition., Study Design and Setting: Open-ended questionnaire sent to a 1-in-6 sample of members of the Finnish Ménière's Association., Patients: Two hundred members of the Finnish Ménière's Association reporting a diagnosis compatible with the condition., Intervention(s): Postal questionnaire, including the question "Please make a list of the main effects that your Ménière's disorder has on your life.", Main Outcome Measure(s): Number of respondents listing 1 or more consequences of their condition. Categories of responses listed and numbers of responses within the different categories as defined by World Health Organization-International Classification of Functioning, Disability and Health., Results: There was a 79% response rate to the overall questionnaire, and 91% of the respondents listed 1 or more consequences of their Ménière's disease, with a mean of 3.4 consequences listed. These were divided according to the categories listed in International Classification of Functioning, Disability and Health. Seventy percent of the respondents listed impairments, 39% activity limitations, 47% participation restrictions, 16% effects on environmental factors, and 28% on personal contextual factors. Although most impairments covered the main symptoms of the condition, 19% of the respondents listed "mental effects." Mobility problems were reported by more than half of those listing activity limitations, with most of the remainder being "communication." The 2 main areas of participation restrictions commonly reported were "community, social and civic life" and "work and employment.", Conclusion: Most individuals with Ménière's disease are able to specify important consequences (principally participation restrictions and activity limitations), many of which are not identified in symptom-orientated approaches.

Objective: To investigate whether individuals with Ménière's disorder are able to recognize positive experiences associated with their condition., Study Design and Setting: Open-ended questionnaire sent to a sample of members of the Finnish Ménière Federation., Patients: Two hundred seventy-two members of the Finnish Ménière Federation reporting a diagnosis compatible with the condition., Intervention: Postal questionnaire., Main Outcome Measure: Number of respondents listing positive experiences related to their condition. Categories of responses listed and number of responses within the different categories., Results: One hundred eighty-one responded; 75% of respondents listed positive experiences associated with their Ménière's disorder. These were categorized into 6 themes: (1) Personal Development; (2) Leisure, Lifestyle, and General Health; (3) Managing the Disorder; (4) Ménière's Disease-specific Responses; (5) Ménière's Society-related Responses; and (6) Interrelationships with Others. The largest number of responses (85) was in the Ménière's Disease-specific Responses category and most related to a better understanding of the condition. The most common response in Interrelationships with Others was Empathy with Other Sufferers. The most beneficial with regard to the disease was the answer for Lifestyle because "they have learned to fulfill their own needs." Giving a positive answer was significantly correlated with Quality of Life., Conclusion: Most individuals with Ménière's disorder are able to identify a number of positive experiences associated with the condition. Understanding and having knowledge of these positive experiences help the patients cope with chronic conditions such as Ménière's disorder. Promotion of positive experiences may form a key element to better adjustment to the different symptoms and provide a key element for successful peer support program.

The etiologies of Meniere's disease and otosclerosis are largely unknown. An association between these two diseases has been proposed on both a clinical and histopathologic basis but the causal relationship is controversial. In this paper we report two families in which both otosclerosis and Meniere's disease are inherited as independent phenotypes suggesting that the two diseases represent different outcomes of the same mutation. Thus the Meniere's disease occasionally seen in otosclerotic patients might not be caused by otosclerosis, but rather by a molecular defect leading to endolymphatic hydrops and/or clinical otosclerosis.

Objective: To study the inheritance of Ménière's disease in the Finnish population., Design: A detailed questionnaire was sent to patients with symptoms resembling Ménière's disease previously examined at the Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland., Patients: The study population comprised 118 patients with symptoms resembling Ménière's disease. The patients were divided into groups based on the diagnostic criteria by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery., Main Outcome Measures: Relatives with Ménière's disease, geographic distribution of birthplaces of grandparents, symptoms, vestibular findings, and audiologic and otoneurologic tests., Results: Approximately 15% of the patients with definite Ménière's disease were found to represent familial disease. The majority of these patients were female, and they had more severe and intense attacks compared with patients with sporadic Ménière's disease. The mode of inheritance is autosomal dominant with incomplete penetrance., Conclusions: A significant part of Ménière's disease is inherited. The use of genetic isolates in which genetic homogeneity can be assumed might lead to the identification of gene defects leading to Ménière's disease.

Objective: To study the prevalence of Menière's disease (MD) in the general population of Southern Finland., Study Design and Setting: Prospective study based on population register data. A questionnaire was sent to 5000 randomly selected persons aged 12 years or more living in the Helsinki University Hospital area. We enquired about whether recipients had experienced vertigo associated with a moving sensation, hearing loss, or tinnitus. For exclusion purposes, we also asked about general illnesses, ear infections, former head and ear traumas, noise exposure, medication, and use of tobacco and alcohol. To assess the validity of the population-based study, we randomly selected a sample of 100 people among those reporting vertigo. They were clinically examined at our vestibular unit. The clinical examination was supplemented by audiologic and otoneurologic tests., Results: The response rate was 63%. In the final study sample of 3116 people, 216 reported the triad of vertigo, hearing loss, and tinnitus. By using the most recent criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery, we were able to identify 16 definite MD patients from the total sample, yielding a prevalence of 513 of 100,000 persons. Among the 16 MD subjects, 9 patients had already been diagnosed with MD and 1 patient was diagnosed during the clinical examination. A peak prevalence of 1709 of 100,000 was seen in the age group 61 to 70 years., Conclusions: Our population-based estimate of MD prevalence is much higher than in previous reports., Ebm Rating: B-3.

Objective: To evaluate the progression of symptoms of dizziness in Ménière's disease (MD) by disease duration., Design: Prospective study of patients with MD. Patients were clinically examined, filled out a questionnaire concerning their symptoms, and were divided into 7 groups based on disease duration., Setting: Tertiary referral clinic., Patients: Sample of 243 consecutive patients with a definite diagnosis of MD who were referred to the vestibular laboratory. Disease duration varied from recent onset to 41 years., Results: No differences were found in frequency, intensity, or duration of vertigo attacks between the different groups. Patients who had MD for less than 10 years experienced less continuous vertigo than those who had MD for more than 20 years. Seventy-five percent of patients who had MD for more than 20 years considered their vertigo attacks severe and 36% still had attacks 1 to 4 times per week. Nausea associated with vertigo was most common among those with a long disease history., Conclusion: Patients with MD can have severe symptoms of dizziness even after a 20-year disease history.

In order to characterize the postural instability by duration of Meniere's disease (MD) we present the results of 180 MD patients tested on posturography. The duration of the disease varied from 4 weeks to 36 years. The patients were clinically examined and they had filled a questionnaire concerning their symptoms. Postural instability was examined by a force platform posturography and the results are expressed as sway velocities (SV). There was no statistically significant difference in the mean SV between groups of different duration of MD. The number of the patients with normal eyes open SV declined by duration of the illness from 73% to 38% but the decline was not statistically significant. The mean age in the different duration groups of MD varied from 47 to 61 years. In general 58% of the patients had their eyes open SV in normal range and 55% when measured eyes closed. When examining the SV between the 4 different hearing stages of MD we found that those belonging into the group III (pure tone average [PTA] 41-70 dB) had significantly higher eyes open and eyes closed SV's than the patients in the group I (PTA under 25 dB).

Objectives: To characterize hearing loss, tinnitus and associative factors in Meniere's disease., Methods: From our vertigo database consisting of 1356 patients, we retrieved 243 patients with Meniere's disease (MD)., Results: Hearing loss was the initial symptom in 13% of cases. Altogether 64% (n=133) of the patients stated that their hearing was reduced during the vertigo attack. The hearing deteriorated more likely during the vertigo attack if the vertigo attack was very intense [r(206)=0.19]. Tinnitus was the initial symptom in 5% of cases. The tinnitus was mild in 38% (n=90), moderate in 32% (n=76) and severe in 30% (n=72) of patients. The intensity of tinnitus correlated with the occurrence of drop attacks [r(237)=0.29], vertigo provoked by head positioning [r(235)=0.25], by physical activity [r(230)=0.33], or by pressure changes [r(239)=0.27]., Conclusion: Prolonged disease causes deterioration of hearing. Intense tinnitus is common in MD and is more often seen in late stage of the disease.

Objectives: To study the vertigo attacks known as Tumarkin attacks or drop attacks (DA). DA are characterized by sudden loss of balance with or without falls but with preserved consciousness, and they are supposedly triggered by changes in the otolith function of Meniere's disease (MD)., Study Design and Setting: Data from 243 consecutive MD patients were collected into a database of an otoneurologic expert system., Results: DA was experienced by 72% (n = 173) of the patients with MD. It correlated with visually provoked vertigo. Gait difficulties, tinnitus, and anxiety were more common in the DA group. Long lasting vertigo attacks were more frequently provoked in the DA subjects by physical strain (58% vs 14%), head movements or changes in head position (71% vs 48%), pressure changes (54% vs 12%), or rapid movements in visual surroundings (65% vs 35%) than in the non-DA subjects., Conclusion: DA are common in MD patients. The abrupt occurrence of DA make them poorly tolerated., Significance: DA are more common in advanced MD.

We retrieved information on 128 patients with vestibular schwannoma (VS) and 243 patients with Ménière's disease (MD) from the database of the otoneurologic expert system (ONE). The patients filled in a questionnaire concerning their symptoms, earlier diseases, accidents and tobacco and alcohol use. This information was then integrated with results of audiometric, otoneurologic and imaging studies. Forty-nine (38%) of the VS patients had the full triad of vertigo, hearing loss and tinnitus. The vertigo mimicked that in MD in 18 (14%) patients. The mean age of these patients was 48 years. There were 7 men and 11 women. The tumour was small (< 2 cm) in eight patients and medium-sized (2-4 cm) in seven patients. The mean attack duration in these 18 patients ranged from 5 min to 4 h. The attacks most commonly (69%) occurred only once or twice a year. Their intensity was moderate. Half of the patients had spontaneous nystagmus. Caloric asymmetry > 25% was detected in 61% of the patients. Tinnitus in these patients was mostly (49%) mild. Intense tinnitus was present only in 12% of patients. Headache was present in 25% of these patients.

Expert systems have been applied in medicine as diagnostic aids and education tools. The construction of a knowledge base for an expert system may be a difficult task; to automate this task several machine learning methods have been developed. These methods can be also used in the refinement of knowledge bases for removing inconsistencies and redundancies, and for simplifying decision rules. In this study, decision tree induction was employed to acquire diagnostic knowledge for otoneurological diseases and to extract relevant parameters from the database of an otoneurological expert system ONE. The records of patients with benign positional vertigo, Meniere's disease, sudden deafness, traumatic vertigo, vestibular neuritis and vestibular schwannoma were retrieved from the database of ONE, and for each disease, decision trees were constructed. The study shows that decision tree induction is a useful technique for acquiring diagnostic knowledge for otoneurological diseases and for extracting relevant parameters from a large set of parameters.

Usefulness of imputation in the treatment of missing values in an otologic database was studied. Missing values were filled in with means (ME), regression (LR) and Expectation-Maximization (EM) imputation methods. A random imputation method (RA) provided baseline results. ME, LR and EM methods agreed on 41-42% of the imputed missing values. The level of agreement between these and RA method was 20-22%. Despite the moderate agreement, discriminant functions were similar and accurate (prediction accuracy 83-99%) for each diagnosis. A lot of data were missing in otoneurotologic tests which have less weight in the diagnosis of vertiginous patients. Consequently, the disagreement of the methods did not affect discriminant analysis. Inputation seems to be a useful method to treat missing data in this database, but future research requires more complete data and advanced imputation methods.

To characterize otologic causes for vertigo, data on 564 patients with the six most common diseases involving vertigo were retrieved from the database of a computer-aided diagnostic system for neurotologic diseases. The diseases were Meniere's disease, vestibular schwannoma, benign paroxysmal positional vertigo, vestibular neuritis, sudden deafness, and traumatic vertigo. The prevalence of tinnitus in the study population was 76%. The most severe forms of vertigo and nausea were found in vestibular neuritis, whereas the most severe case of tinnitus appeared in Meniere's disease. Of the patients with vestibular schwannoma, 49% had had vertigo. A linear discrimination analysis using case history classified 90% of the patients into correct groups. The key questions discriminating between the diseases concerned the frequency and duration of vertigo attacks, the duration of hearing loss and vertigo, and the occurrence of head injury. Making a correct diagnosis during the first office visit can be difficult, especially for sudden deafness, vestibular schwannoma, and Meniere's disease. Neurotologic and audiometric information was of minor value in distinguishing between these six diseases. Vestibular schwannoma had significantly greater asymmetry in electronystagmography and smaller gains in smooth pursuit in comparison with the other disease. Factorial analysis did not aid the clustering of these diseases.

We have developed an interactive database for vertigo than can be used to assist in the diagnostic procedure and to store the data in a form of a database. The database offers the possibility to split and reunite the collected information in a desired way. The database contains detailed information about patient history, symptoms and findings in neurotological, audiological and imaging tests. The symptoms are classified into three sets of questions: vertigo (including postural instability), hearing loss and tinnitus, and provoking factors. Confounding disorders are screened. The neurotological tests involve saccades, smooth pursuit, posturography and caloric test. In addition, findings in specified antibody testing, clinical neurotological tests. MRI, brain stem audiometry and electrocochleography are included. The input information can be applied in an expert system ONE for vertigo work-up. The database is user-friendly. Besides diagnostic purposes the database is excellent for research purposes, and combined with the expert system it works as a tutorial guide for medical students.

An otoneurological expert system (ONE) was developed to help collect data and diagnose the work-up of vertigo of both central and peripheral diseases causing vertigo. Patient history and otoneurological and other examination results are used in the reasoning process. The history is interactively collected and is complemented with clinical examination results. The case history data can be either mandatory or supportive. Mandatory questions are used to confirm a diagnosis, and conflicting answers are used to reject an unlikely disease. Supportive questions support or suppress a diagnosis, but their presence is not obligatory. The reasoning procedure of ONE scores every question independently for different diagnoses, depending on how well they agree with the symptom entity of a disease. Diagnostic criteria are set for each disease, in Meniere's disease, for example, the full triad is required. Graphic displays illustrate the linear and nonlinear correlation between the symptoms and diseases. For instance, both second-long Tumarkin-type attacks and attacks lasting hours give a high score while intermediately long attacks score much lower in Meniere's disease. To be able to take even rare diseases into consideration we try to diminish the possibility of a wrong decision rather than maximize the likelihood of reaching only one right decision.